94-24953. Federal Employees Health Benefits Program: Debarment

[Federal Register Volume 59, Number 195 (Tuesday, October 11, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-24953]


Federal Register / Vol. 59, No. 195 / Tuesday, October 11, 1994 /

[[Page Unknown]]

[Federal Register: October 11, 1994]


                                                   VOL. 59, NO. 195

                                          Tuesday, October 11, 1994

OFFICE OF PERSONNEL MANAGEMENT

5 CFR Part 890

RIN 3206-AG03

 

Federal Employees Health Benefits Program: Debarment

agency: Office of Personnel Management.

Action: Final rule.

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summary: The Office of Personnel Management (OPM) is issuing final 
regulations to incorporate into regulations the statutory requirement 
that carriers in the Federal Employees Health Benefits (FEHB) Program 
may not deny claims for services or supplies due to the debarment of 
the providers who supplied them if the claimants could not have known 
that the provider was debarred. The purpose of these regulations is to 
comply with the provision of law that requires OPM to prescribe 
regulations on this issue.

effective date: November 10, 1994.

for further information contact: Margaret Sears [phone].

supplementary information: On May 10, 1994, OPM published interim 
regulations in the Federal Register (59 FR 24030) clarifying that 
carriers cannot deny claims based on debarment if there was no 
reasonable way the claimant could have known that the provider was 
debarred. When an individual who has not previously been notified of a 
provider's debarment submits a claim for services or supplies furnished 
by a debarred provider, the carrier must (1) honor the claim under the 
terms of its contract with OPM, and (2) inform the individual about the 
debarment of the provider and the minimum period of time remaining 
under the terms of the debarment.
    In practical terms, this generally means that the first claim(s) an 
enrollee submits for services or supplies received after a provider has 
been debarred, but before the enrollee has been informed of the 
debarment, is (are) paid to the same extent it (they) would have been 
paid had the provider not been debarred. The carrier must, at the same 
time, inform the enrollee concerning the debarment. The carrier will 
deny any subsequent claims for service or supplies furnished during the 
period the provider is debarred.
    OPM received no comments on the interim regulations.

Regulatory Flexibility Act

    I certify that these regulations will not have a significant 
economic impact on a substantial number of small entities because they 
primarily affect Federal employees and annuitants.

E.O. 12866, Regulatory Review

    This rule has been reviewed by OMB in accordance with E.O. 12866.

List of Subjects in 5 CFR Part 890

    Administrative practice and procedure, Government employees, Health 
facilities, Health insurance, Health professions, Hostages, Reporting 
and recordkeeping requirements, Retirement.

Office of Personnel Management.
James B. King,
Director.

    Accordingly, under authority of 5 U.S.C. 8913, OPM is adopting its 
interim regulations under 5 CFR part 890 as published on May 10, 1994 
(59 FR 24030) as final rules without change.

[FR Doc. 94-24953 Filed 10-7-94; 8:45 am]
BILLING CODE 6325-01-M